5101:1-5-50 Disability financial assistance: payments.

(A) General principles

(1) "Disability financial assistance (DFA) payments" are those payments made to an individual or family (assistance group) which represent the difference between the countable income and the appropriate DFA payment standard. All DFA payments are calculated based on a thirty-day month.

(2) The county agency that serves the county in which a person is receiving DFA and is participating in an alcohol or drug addiction program, shall designate a protective payee for purposes of receiving and distributing financial assistance provided under the DFA program to the person.

(B) Beginning date of DFA

(1) Cash assistance for eligible DFA applicants begins on the date that all eligibility factors are met or the date a signed, completed application is filed, whichever is later. The date all eligibility factors are met is not necessarily the date verifications are provided to the county agency. Verification merely establishes that an eligibility factor has been met.

(2) DFA payments may be authorized retroactively as a result of a hearing decision, court order or when the county agency determines that the DFA was erroneously denied, terminated or delayed and corrective action is being taken.

(3) DFA may not be issued to supplement prorated Ohio works first (OWF) payments.

(4) The county agency shall prorate the payment when an assistance group has eligibility for less than a full month's grant. The county agency shall issue a prorated payment for initial assistance or for DFA covering prior months.

(C) Concurrent receipt

(1) "Concurrent receipt of assistance" is defined as the receipt of assistance by an assistance group under more than one public assistance money grant in the same month. The receipt of public assistance, from two or more different states, for a duplicate time period, also constitutes concurrent receipt of assistance.

(2) An assistance group member shall not be eligible to receive or have his needs covered by DFA in more than one assistance group or more than one county in any given month.

(3) An individual whose needs are met by the supplemental security income (SSI) program shall not be eligible to have his needs included in a DFA assistance group concurrently.

(4) If the assistance group is receiving or is believed to be receiving cash assistance from another state, the county agency must determine at what point the assistance group became ineligible for cash assistance in the former state prior to approving DFA. Prior to the approval of DFA, the county agency must contact the other state to verify when the assistance group became ineligible and the time period for which assistance was last authorized.

(D) Reporting requirements

(1) The county agency shall take prompt appropriate action following any reported changes which may affect an assistance group's eligibility or the amount of the grant.

(2) Reporting responsibilities are not met when a family group does not make an accurate, full and complete disclosure of the facts bearing upon the family group's eligibility within ten days of the date that any change specifically identified in rule 5101:1-2-20 of the Administrative Code occurs.

(3) Failure to disclose the facts necessary for a correct determination of eligibility is considered to be beyond the family group's control when there is evidence that the following have occurred:

(a) The individual person was too ill or too disturbed to understand his responsibility to report a change in his circumstances;

(b) The individual was senile or otherwise limited mentally, or had difficulty understanding the instructions, which prevented him from assuming responsibility to report.

(E) Effective date of budget adjustment

(1) For any change in circumstances that may affect the assistance group's eligibility or the amount of DFA to which it is eligible, the county agency shall take appropriate action so that the DFA payment is properly adjusted by the first day of the second month following the month of change, subject to the requirements of prior notice and the hearing process.

(2) If a family group has a change which is not specifically listed as a reporting requirement in rule 5101:1-2-20 of the Administrative Code, and the change is not reported by the family group until the next reapplication(or between reapplication periods), the effective date of the budget change shall be effective by the first day of the second month following the month in which the change was reported or the county agency became aware of the change.

(F) Willful withholding of information

Failure to disclose is considered to be willful withholding of information in any of the following circumstances:

(1) A willful misstatement (either oral or written) made by a family group in response to oral or written questions from the county agency concerning the family group's income, resources or other circumstances which may affect the amount of payment. Such misstatement may include understatements of amounts of income or resources and omission of an entire category of income or resources;

(2) A willful failure by the family group to report changes in income, resources or other circumstances which may affect the amount of payment, if the county agency has clearly notified the family group of an obligation to report such changes; or

(3) A willful failure by the family group to report receipt of a payment which the family group knew represented an erroneous payment.

(G) Determination of underpayments

(1) An underpayment occurs when the assistance group or family group has met the reporting responsibility as set forth in rule 5101:1-2-20 of the Administrative Code, and the appropriate and timely action was not taken by the county agency, resulting in either:

(a) An assistance group receiving less DFA than the amount that the assistance group was eligible to receive; or

(b) An eligible assistance group receiving no DFA due to a denial or termination of DFA benefits.

(2) An underpayment shall be issued for the period, not to exceed twelve months, prior to whichever of the following occurred first:

(a) The date that the county agency receives a request for an underpayment from an assistance group; or

(b) The date that the county agency is notified or otherwise discovers that a loss to an assistance group has occurred.

(H) Calculation and issuance of underpayments

(1) The amount of the underpayment is the difference between the amount of DFA which an assistance group was eligible to receive for a particular period of time and the lesser amount which the assistance group actually received for that same period of time.

(2) In calculating the underpayment amount for situations involving the untimely processing of income, the county agency shall use the actual income received by the assistance group. If all of the documentation is not available, the county agency shall follow the provisions set forth in rule 5101:1-2-20 of the Administrative Code.

(3) In situations where the error does not involve the untimely processing of income, the county agency shall use the converted income already established for the month(s).

(4) When there is earned income, the appropriate deductions (i.e., earned income disregard, child care costs) are allowed in order to compute the amount of an underpayment.

(5) Underpayments which are not offset against erroneous payments are adjusted by authorization of an auxiliary payment, regardless of whether the assistance group is in receipt of DFA.

(6) An erroneous payment resulting from an administrative error shall not be recovered when all of the following criteria are met:

(a) The family group met all of its reporting responsibilities as set forth in rule 5101:1-2-20 of the Administrative Code, and did nothing to cause the erroneous payment.

(b) The family group was not aware of the error or erroneous payment and did not have any information which should have made the family group aware of the error or put the family group on notice of the error.

(c) Without notice of the error, the family group relied upon the honest belief that the assistance group was entitled to the payment. The family group must provide the county agency with clear evidence that one of the following three actions has been taken:

(i) The family group has spent the money; or

(ii) The family group has given up possession of the money; or

(iii) The family group's situation has changed (e.g., quit a job, entered into a purchase contract) to the extent that the repayment of the money would put the family group into a worse situation than it would have been in if the assistance group had never received the erroneous payment.

(I) Erroneous payments

(1) The JFS 07095, "Erroneous Benefit Determination" (rev. 10/2007), shall be completed on all cases in which an erroneous payment has been found. One copy of the JFS 07095 shall be retained in the case record. another copy shall be retained in a central file so it may be used to compile information for reports required on cases involving willful withholding of information.

(2) For purposes of this rule "erroneous payments" are defined as benefits received by the assistance group that:

(a) Exceed the amount that the assistance group was eligible to receive; or

(b) The assistance group was not eligible to receive including payments made as a result of misrepresentation or fraud, and payments made due to an error by the recipient or by the county agency.

(3) An erroneous payment may occur because of any change in the family group's situation which decreases the level of assistance for which the assistance group is eligible.

(4) Erroneous payments are classified according to whether reporting responsibilities set forth in rule 5101:1-2-20 of the Administrative Code were met and the failure of the county agency to make the appropriate budget change.

(5) Erroneous payments may occur even when the family group meets the reporting responsibilities set forth in rule 5101:1-2-20 of the Administrative Code. The erroneous payment may be due to the pendency of a state hearing or to an administrative error.

(J) Erroneous payment determination

Upon notification of a change in the family group's needs, income or resources, the county agency shall make the determination based on the following:

(1) The date the change in income, resources or need occurred; the date the change was reported to the county agency; and whether the change was a reporting requirement change set forth in rule 5101:1-2-20 of the Administrative Code; and

(2) The amount of DFA erroneous payment by month. When there is earned income, the erroneous payment is calculated by using the actual earnings, minus any appropriate disregards;

(3) Whether the family group met or failed to meet the reporting responsibilities set forth in rule 5101:1-2-20 of the Administrative Code;

(4) Whether the failure to report was willful;

(5) The amount of liquid assets available, including exempt and disregarded income; and

(6) The amount of erroneous payment that can be adjusted through grant reduction for two months.

(K) Recovery of erroneous payments

(1) Erroneous payments may be recovered by the following methods:

(a) Lump sum repayment;

(b) Monthly repayment;

(c) Grant reduction for a two-month period; and/or

(d) Referral to the county prosecutor for civil collection.

(2) All cases in which there is probable cause to believe that fraud has been committed shall be referred to the county prosecutor. The county agency does not have the authority to collect DFA erroneous payments through judicial proceedings and small claims court unless the county agency is represented by the county prosecutor.

(3) An erroneous payment may be collected by grant reduction only when the assistance group has liquid assets to meet its needs according to the DFA payment standard. "Liquid assets" refers to any income and/or any personal property reserve which is immediately transferable to cash. The erroneous payment is collected by adjusting the grant in two subsequent months by the amount of the erroneous payment or by the amount of available liquid assets, whichever is less.

(4) The amount of an erroneous payment remaining after grant reduction may be recovered by referring the case to the county prosecutor for civil collection. The amount remaining after grant reduction may affect a repayment agreement. The county agency and county prosecutor shall decide when a referral is cost-effective.

(5) In all phases of erroneous payment collection, the county agency shall provide prior notice to the assistance group. Erroneous payment collection activity that does not affect the amount or receipt of the DFA grant does not require prior notice.

(6) Recoupment of erroneous payments in an amount of thirty-five dollars or less owed by former DFA assistance groups shall be waived, as it is not cost-effective.

(7) The county agency may recover erroneous payments made during the pendency of a state hearing. When specific amounts of erroneous payments are stipulated in the decision, those amounts are binding.

(L) Treatment of erroneous payment activity against former general assistance recipients

Erroneous payment activity against former general assistance recipients ceased on August 1, 1997. No claims shall be established nor collection activity continued on or after that date. The exception to this requirement shall be claims established or collection initiated as a result of a court order requiring restitution. The county agency shall follow the court order in these instances.

Replaces: 5101:1-5-50

Effective: 05/01/2010
R.C. 119.032 review dates: 05/01/2015
Promulgated Under: 111.15
Statutory Authority: 5115.03
Rule Amplifies: 5115.03 , 5115.23
Prior Effective Dates: 1/1/74, 10/1/75, 11/1/76, 12/31/77, 10/1/78, 10/26/78,
12/1/78, 5/1/79, 9/21/79, 12/1/81, 5/1/82, 7/1/83, 11/1/83 (Temp.), 11/11/83, 1/1/84, 6/1/84, 7/15/84 (Temp.), 10/1/84, 2/1/85 (Emer.), 5/2/85, 8/1/85 (Emer.), 10/17/85, 8/1/86 (Emer.), 10/3/86, 5/1/87 (Emer.), 7/30/87, 4/1/88 (Emer.), 6/10/88, 7/1/88 (Emer.), 9/25/88, 4/1/89(Emer.), 4/24/89, 7/1/90, 10/1/90, 10/1/91 (Emer.), 12/20/91, 4/1/92 (Emer.), 6/30/92, 10/1/92 (Emer.), 12/1/92 (Emer.), 1/1/93, 2/11/93, 9/1/93, 9/1/94, 5/1/95, 8/1/95 (Emer.), 10/30/95, 1/1/96, 5/1/97, 7/24/97 (Emer.), 10/1/97, 10/1/97 (Emer.), 12/11/97, 12/30/97, 7/1/98, 7/1/03 (Emer.), 9/30/03, 7/1/05(Emer.), 9/29/05, 11/1/07